Health

Is brain death absolute?

Sunday, June 23, 2019

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WE know that when our heart stops beating we die. However, if our brain dies, do we also die?

Brain death has been defined as the irreversible cessation of all functions of the entire brain, including the brainstem, (which is the area responsible for basic body functions such as breathing, swallowing, your heart rate, blood pressure, and whether you are awake or sleepy).

Before the advent of technological interventions in medicine, a human being was either alive or dead. Our senses and perception could tell us if someone was alive or dead. If circulation and respiration had ceased, we could judge the moment of death. However, now we cannot be absolutely sure.

We are currently in the age and possibilities of organ transplantation, whereby an important body organ can be surgically removed from one person and placed in the body of another person, to replace their damaged or diseased organ. Worldwide, the kidneys are the most commonly transplanted organ, followed by the liver and the heart.

Organ donation

The benefits of organ donation are several, including comfort and consolation for individuals that organs donated may help to save other lives. The donation of the organs of a deceased donor may save up to eight lives in technologically advanced countries when all the important organs are counted, and lead to a much-improved quality of life if body tissues and eyes are also provided.

Organ transplantation, however, is now a very lucrative business, and so there has been much concern regarding possible conflicts of interest by health professionals and institutions involved in organ recovery for transplantation.

Customarily, the basic principle guiding organ donation and procurement is the “dead donor rule”, which states that a person must be dead before their vital organs are extracted for transplantation. The presumption is that the dead body is a corpse, and so removing vital organs from a corpse does no harm. However, if we cannot be certain that the individual is dead, then removing their vital organs may be a matter of life and death.

Morally unacceptable

It is morally unacceptable to cause mutilation or death of a human being, even if it is to save the life of another human being. So while organ donation is an act of charity and organs are always in short supply worldwide, organs should never be removed from a person without respecting objective criteria regarding the death of the donor.

Lately, there has been much debate in many jurisdictions regarding the use of brain-dead individuals as organ donors, since many believe that a diagnosis of brain death does not mean that it is morally or scientifically certain that the individual is dead.

We should note that the circulation of blood and breathing for brain-dead individuals can be done by technologically sophisticated machines. Further, the brain-dead individual may have undergone a severely traumatic event, resulting in the complete and irreversible cessation of all brain functions. Consequently, genuinely brain-dead individuals never wake up, although a ventilator may keep their organs alive and functioning for a period of time.

Balancing benefit and harm

So the challenge in the balance of benefit and harm is determining how to wait long enough to be certain that all functions of the entire brain have ceased and are irreversible, (that is, the person is truly dead), while not waiting too long where the person's organs have begun to deteriorate and, therefore, are not transplantable.

In the transplantation world, brain death is declared while the patient still has a beating heart because removal of the needed organs must be done before they begin to deteriorate (which occurs when blood stops circulating). The matter is complicated, however, by the reality that with their blood flowing, brain-dead individuals can digest food, brain-dead children can grow, brain-dead pregnant women in the past have delivered healthy babies and produced milk, and the wounds of brain-dead patients have been known to heal.

It is therefore difficult to convince people under these circumstances that the person is dead.

What would you do?

There are good people who support vital organ donation after brain death has been determined, and there are good people who oppose it. Further, good individuals have been known to will their organs for donation in the case of any untimely death. Others may have to decide whether to undergo transplant surgery, if available.

If it were one of your loved ones who needed that organ to stay alive, how would you feel on the matter? If your close relative was in a motor vehicle crash and declared brain dead, would you authorise the removal of vital organs to save the life of another? What if the life to be saved was that of another family member?

Dr Derrick Aarons MD, PhD, is a consultant bioethicist and family physician; a specialist in ethical issues in health care, research, and the life sciences; the health registrar and head of the health secretariat for the Turks and Caicos Islands, and a member of UNESCO's International Bioethics Committee.


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